You are looking at information for: Washington DC
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Premiums and benefits |
Kaiser Permanente Medicare Advantage Value DC (HMO-POS) |
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) |
Kaiser Permanente Medicare Advantage High DC (HMO-POS) |
|---|---|---|---|
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DESCRIPTION |
YOU PAY |
YOU PAY |
YOU PAY |
|
Monthly premium |
$0 |
$30 |
$105 |
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Annual deductible |
None |
None |
None |
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Doctor office visits |
$5 Primary $40 Specialist |
$5 Primary $35 Specialist |
$5 Primary $30 Specialist |
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Emergency care We cover emergency care anywhere in the world |
$110 per emergency department visit |
$110 per emergency department visit |
$120 per emergency department visit |
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Urgently needed services
We cover urgent care anywhere in the world |
$40 per office visit |
$35 per office visit |
$30 per office visit |
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Preventive services1 |
No charge |
No charge |
No charge |
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Inpatient hospitalization |
$290 per day for days 1 through 5 No charge for the remainder of your stay |
$245 per day for days 1 through 5 No charge for the remainder of your stay |
$225 per day for days 1 through 5 No charge for the remainder of your stay |
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Outpatient surgery |
$290 |
$130 |
$125 |
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Skilled nursing facility Up to 100 days per benefit period |
$0 per day for days 1 through 20 $214 per day for days 21 through 100 |
$0 per day for days 1 through 20 $203 per day for days 21 through 100 |
$0 per day for days 1 through 20 $160 per day for days 21 through 100 |
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Lab, X-ray |
$0 Lab $20 X-ray |
$0 Lab $15 X-ray |
$0 Lab $10 X-ray |
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MRI, CT, PET |
$170 |
$100 |
$00 |
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Durable medical equipment |
20% |
20% |
20% |
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Ambulance service Per one-way trip |
$275 |
$225 |
$225 |
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Transportation |
Not covered |
$0 for 24 one-way trips per calendar year to take you to and from a network provider. For nonemergency transportation only. |
$0 for 24 one-way trips per calendar year to take you to and from a network provider. For nonemergency transportation only. |
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Fitness program One Pass®2 |
Not covered |
No cost for membership to any participating gym, on-demand workouts, digital fitness programs, and one fitness kit annually for strength, yoga, or dance. |
No cost for membership to any participating gym, on-demand workouts, digital fitness programs, and one fitness kit annually for strength, yoga, or dance. |
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Annual maximum out-of-pocket |
$6,900 |
$6,900 |
$5,700 |
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Comprehensive dental plan
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$0 copay per visit The comprehensive dental plan also includes a $1,500 annual allowance3 for more extensive care, such as fillings, crowns, dentures, root canals, and more |
$0 copay per visit The comprehensive dental plan also includes a $2,500 annual allowance3 for more extensive care, such as fillings, crowns, dentures, root canals, and more |
$0 copay per visit The comprehensive dental plan also includes a $1,000 annual allowance3 for more extensive care, such as fillings, crowns, dentures, root canals, and more |
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Over the counter (OTC) wellness benefit4 Quarterly allowance to order items such as cold remedies, antacids, pain relievers, etc. |
$70 quarterly allowance |
$80 quarterly allowance |
$70 quarterly allowance |
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Hearing aids5 |
$1,000 allowance per ear, every 36 months, through Kaiser Permanente audiology centers |
$1,000 allowance per ear, every 36 months, through Kaiser Permanente audiology centers |
$1,000 allowance per ear, every 36 months, through Kaiser Permanente audiology centers |
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Medicare Explorer by Kaiser Permanente6 |
If you travel outside any Kaiser Permanente service area, but inside the United States or its territories, we cover preventive, routine, follow-up, or continuing care office visits obtained from out-of-network Medicare providers not to exceed a benefit maximum of $1,200 in covered plan charges per calendar year. See Evidence of Coverage for details. |
If you travel outside any Kaiser Permanente service area, but inside the United States or its territories, we cover preventive, routine, follow-up, or continuing care office visits obtained from out-of-network Medicare providers not to exceed a benefit maximum of $1,200 in covered plan charges per calendar year. See Evidence of Coverage for details. |
If you travel outside any Kaiser Permanente service area, but inside the United States or its territories, we cover preventive, routine, follow-up, or continuing care office visits obtained from out-of-network Medicare providers not to exceed a benefit maximum of $1,200 in covered plan charges per calendar year. See Evidence of Coverage for details. |
1 $0 copay for all preventive services covered under Original Medicare at zero cost sharing.
2 Not available with Kaiser Permanente Medicare Advantage Value Balt (HMO), Kaiser Permanente Medicare Advantage Value MD (HMO), or Kaiser Permanente Medicare Advantage Value DC (HMO-POS) plans. One Pass® is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions and is a voluntary program. The One Pass program and amenities vary by plan, area, and location. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. One Pass is not responsible for the services or information provided by third parties. Individuals should consult an appropriate health care professional before beginning any exercise program and/or to determine what may be right for them.
3 With a 50% coinsurance. Annual allowance varies by plan option. See your Evidence of Coverage for details. Dental benefits underwritten by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and administered by LIBERTY Dental Plan.
4 Please refer to your Evidence of Coverage for details. OTC benefits may change each year on January 1.
Each order must be at least $20. Any unused portion of the quarterly benefit limit will not carry forward to the next quarter. Your order may not exceed your quarterly benefit limit. Limitations and restrictions may apply. Cash, check, credits cards, or money orders are not accepted.
5 Hearing aid allowance can only be used for hearing aids purchased at Kaiser Permanente audiology centers. To find the nearest Kaiser Permanente audiology center, visit kp.org/hearingcare.
6 Not available with Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS), Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS), Kaiser Permanente Medicare Advantage Value Baltimore (HMO), Kaiser Permanente Medicare Advantage Value MD (HMO), and Kaiser Permanente Medicare Advantage Liberty (HMO) plans. Members are responsible for any charged amounts for covered services that exceed the annual allowance maximum of $1,200. Coverage limited to inside the United States and its territories. See your Evidence of Coverage for details. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
For more information about benefits, please view the 2025 Summary of Benefits.
These plans include Medicare Part D prescription drug coverage. Copay and coinsurance amounts below are for up to a month’s supply. You can save on most refills of a 3-month supply through our Mail Order Pharmacy and have them mailed to your home at no extra charge. Some medications are not eligible for Mail Order Pharmacy. Mail Order Pharmacy can deliver to addresses in MD, VA, DC, and certain locations outside the service area.
| Kaiser Permanente Medicare Advantage Value DC (HMO-POS) | Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) | Kaiser Permanente Medicare Advantage High DC (HMO-POS) | |||
|---|---|---|---|---|---|
| DESCRIPTION | YOU PAY | YOU PAY | YOU PAY | ||
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Initial coverage stage For up to a 30-day supply from an in-network pharmacy with preferred cost sharing. When the total drug costs paid by you and any Part D plan reach $5,030, you move into the coverage gap stage. |
$0 Preferred generic (Tier 1) $7 Generic (Tier 2) $45 Preferred brand-name (Tier 3) $100 Nonpreferred brand-name (Tier 4) 33% Specialty (Tier 5) $0 Injectable Part D vaccines (Tier 6) |
$0 Preferred generic (Tier 1) $12 Generic (Tier 2) $45 Preferred brand-name (Tier 3) $100 Nonpreferred brand-name (Tier 4) 33% Specialty (Tier 5) $0 Injectable Part D vaccines (Tier 6) |
$0 Preferred generic (Tier 1) $12 Generic (Tier 2) $42 Preferred brand-name (Tier 3) $100 Nonpreferred brand-name (Tier 4) 33% Specialty (Tier 5) $0 Injectable Part D vaccines (Tier 6) |
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Catastrophic coverage stage |
After your yearly out-of-pocket drug costs reach $2,000, you pay $0. |
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Our Mail-Order Pharmacy5 Save time and money with prescriptions mailed right to your home. |
$0 copay for up to a 90-day supply for preferred generic and generic (Tiers 1 and 2). |
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Enhance your health and well-being by combining the affordable benefits of Advantage Plus with your Kaiser Permanente Medicare Advantage (HMO) plan. Choose Option 1, Option 2, or both options for maximum coverage.
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Connect with a licensed Kaiser Permanente Medicare specialist in your area, on your schedule. Simply complete the form (click or tap to open) and we’ll contact you to set up an appointment.
Find a seminar in your area to learn more about our Kaiser Permanente Medicare health plans.
Kaiser Permanente is an HMO and HMO-POS plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll.
For accommodations of persons with special needs at meetings, call 1-866-975-7803 (TTY 711) 7 days a week, 8 a.m. to 8 p.m.
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© 2024-2025 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Page last updated on October 1, 2024 at 12 a.m. EST
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